運用悲傷輔導原則協助愛滋病患配偶渡過喪偶之悲傷期

Utilizing Grief Counseling Principles to Assist a Woman Whose Husband Died of AIDS

本個案報告運用Worden之「悲傷輔導原則」，探討愛滋病患太太在喪偶期間的悲傷反應及敘述護理人員如何協助其渡過悲傷期並完成「哀悼的四個任務」。資料收集採田野研究法，依Worden提出的悲傷反應自15篇行為過程紀錄的資料加以分析。結果發現個案的悲傷反應在感覺方面包括悲傷、憤怒、愧疚感與自責、焦慮、孤獨感、疲倦、無助感、驚嚇及解脫感；生理感官知覺方面為失眠、心悸、胸悶；認知方面為不相信、困惑、沉迷於對逝者思念及感到逝者仍存在；行為方面有失眠、食慾障礙、社會退縮行為、避免提起失去的親人、尋求與呼喚、嘆氣、哭泣等。個案喪偶後約6個月已逐漸完成（1）接受失落的事實、（2）經驗悲傷的痛苦、（3）重新適應一個逝者不存在的新環境及（4）將對逝者的情感重新投注在未來的生活上等四個哀悼的任務。期望藉由此個案研究讓護理人員對喪親的悲傷反應更為敏感與接納，並嘗試在陪伴遺族時善用悲傷輔導技巧，協助喪親者適當的哀悼，重新適應一個逝者不存在的新環境。

This case study report utilized the grief counseling principles proposed by Worden to elucidate the grief responses of a woman whose husband died of AIDS. It also described the nursing care provided by staff nurses to assist the woman to get through the period of grief by achieving ”the four goals of grief”. Fifteen in-depth interviews were performed and field notes were collected. As the study reports, the grief responses of the wife were: affective expressions, including grief, anger, guilt, self blame, anxiety, loneliness, fatigue, helplessness, and shock; physical expressions, including insomnia, palpitations, and chest tightness; cognitive expressions, including disbelief, confusion, a sense that the loved one is still alive; and behavioral expressions, including insomnia, poor appetite, social withdrawal, avoidance of mentioning the deceased, searching, sighing and sobbing. After her husband had been deceased for six months, the wife completed the phases of 1) acceptance of loss, 2) experiencing grief and pain, 3) adapting to a new environment without the deceased, and 4) redirecting the positive feelings towards the deceased in building a brighter future. This case report will help clinical nurses to understand how to assist families with HIV/AIDS through proper grief counseling, and thus how to guide them through grief.